Chapter 43 - Surgery for Vertigo Flashcards
Meniere’s Triad
Vertigo lasting 20+ minutes, more than 1 episode
Hearing loss
Tinnitus or aural fullness
Surgical options for Meniere’s
intratympanic steroid endolymphatic sac surgery intratympanic gentamicin ablation surgical labrinthectomy vestibular nerve section
Do any surgeries for Meniere’s improve hearing?
No
Procedures for intractable or recurrent BPPV
posterior SCC occlusion- prevents particles from activating the canal ampulla
vestibular neurectomy (rare)
singular neurectomy- remove innervation to posterior canal ampulla (technically difficult, risk of hearing loss)
How do you balance after a labryinthectomy?
Vestibular compensation - CNS process
Expedited by PT
Can BPPV follow vestibular neuritis?
Yes, it often does
PT in addition to canalith repositioning can especially help in this setting
Presentations of S SCC dehiscence
CHL, ear fullness/autophony (like patulous ET), vertigo
Key finding telling you that CHL is from S SCC dehisence not otosclerosis
intact ipsilateral stapedial reflex
Non-surgical treatments for vertigo
Based on cause... vestibular rehab diuretic/migraine med/vestibular suppressant dietary change canalith reposition
When to consider surgery for vertigo
caused by unilateral peripheral vestibular dysfunction, absolute certainly of which side is affected
PLUS: disabling
PLUS: no evidence of central system dysfunction that would impair postop compensation
Reporting Meniere’s control after treatment
18-24 mo after treatment, divide # episodes in 6 mo by # of episodes in 6 mo prior to treatment
A: 0% B: 1-40% (substantial control) C: 41-80% (partial control) D: 81-120% (No control) E: >120% (worse) F: Secondary treatment required due to disabling vertigo
Ablative vs non-ablative procedures for Meniere’s disease
Ablative achieves better vertigo control, but requires vestibular compensation to limit post-treatment disequilibrium
Types of endolymphatic shunt surgery
Shunt: place synthetic shunt to drain endolymph
Drainage: incision of sac to allow endolymph drainage
Decompression: improve sac function of endolymph absorption
Sham Surgery Trial Thompson 1981
Compared mastoidectomy w/o decompression to endolymphatic shunt
Found that benefits of shunt surgery were nonspecific, basically sham resulted in similar results as shunt surgery
Approaches to vestibular nerve section
Middle fossa
Retrolabyrinthine
Restrosigmoid
Translayrinthine
Potential complications of vestibular nerve section
facial paralysis, hearing loss, CSF leak, persistent disequilibrium
Tullio’s phenomenon
Sound-induced dizziness, vertigo, nystagmus
Occurs with fenestration of bony labyrinth, syphilis, lyme disease
What is S SC dehiscence
thinning of absence of T bone overlying S SCC
Symptoms of S SC dehiscence
sound, pressure or vibration-induced vertigo
low frequency CHL, may have better than 0dB BC threshold
Autophony and blocked ear feeling
Tests to confirm S SC dehisence
VEMP- low thresholds
High Res CT dehiscence of bony covering separating dura from SCC
Cause of S SC dehiscence
multifactorial
incomplete ossification
chronic INC ICP
temporal-mastoid encephalocele associated
Treatment options for SSCD
educate
PE tubes for pressure-induced vertigo
ear plugs for autophony
surgery to plug (w/ cartilage) or resurface SC if fail/intractable
Approaches for SSC surgery
Middle cranial fossa (#1)
Transmastoid
